5.12.2014 1 Peripheral nervous system 1) Spinal nerves – dorsal roots, plexuses 2) Cranial nerves – I-XII 3) Autonomic nervous system Meninges Organs Back Ventral side of trunk, limbs Sympaticus Plexuses Dorsal branches of spinal nerves • Segmental organization • Medial and lateral branch • Sensoric and motor Dorsal branches of spinal nerves N. suboccipitalis – C1 N. occipitalis major – C2 N. occipitalis tertius – C3 Nn. clunium Intercostal nerves Segmental organisation Posterior and anterior branch Lateral cutaneus branches Anterior cutaneus pranches 5.12.2014 2 PLEXUS CERVICALIS rami ventrales nervorum spinalium C1 – C4 (eventually C5) three loops (ansae) Branches: sensoric motor Sensoric branches: N. occipitalis minor N. transversus coli Nn. Supraclaviculares N. auricularis magnus PLEXUS CERVICALIS – MOTOR BRANCHES Rami musculares mm. praevertebrales mm. intervertebrales mm. scaleni ONLY PARTLY: m. sternocleidomastoideus m. trapezius ANSA CERVICALIS PROFUNDA Radix superior ansae cervicalis prof. (accompanies nervus XII.) Radix inferior ansae cervicalis prof. N.hypoglossus m.thyrohyoideus radix sup.radix inf. m.geniohyoideus m.omohyoideus venter sup.m.omohyoideus venter inf. m.sternothyroideus m.sternohyoideus Innervation of infrahyoid muscles NERVUS PHRENICUS rr. phrenici (motor.) rr. pericardiaci (sen.) rr. phrenicoabdominales (sen.) PLEXUS BRACHIALIS rami ventrales nervorum spinalium C5 – Th 1 innervation of upper extremity, heterochtonic muscles of thorax and back Fissura scalenorum supraclavicular part infraclavicular part 5.12.2014 3 Medial cord: Nervus ulnaris Nervus cutaneus brachii medialis Nervus cutaneus antebrachii medialis Radix medialis nervi mediani Lateral cord: Nervus musculocutaneus Radix lateralis nervi mediani Posterior cord: Nervus radialis Nervus axillaris Nervus medianus Radix medialis et lateralis Sulcus bicipitalis medialis Canalis pronatorius Forearm: Muscles of anterior group (exceptions) Nervus ulnaris Medial cord Sulcus bicipitalis medialis Sulcus nervi ulnaris Forearm: Musculus flexoris carpi ulnaris Medial part of musculus flexor digitorum profundus 5.12.2014 4 Nervus medianus: Muscles of thenar (exceptions) Nervus ulnaris: Muscles of hypothenar Musculi interossei Musculi lumbricales 3-4 Musculus adductor pollicis Caput profundum musculi flexoris pollicis brevis Innervation of the palmar side of hand Sensoric innervation Nervus radialis Arm: Muscles of posterior group Skin (posterior and lateral side) Forearm: Superficial and deep branch Muscles of latral and posterior group Skin (posterior side) Innervation of the dorsal side of hand Nervus musculocutaneus Arm: Muscles of anterior group – penetrates coracobrachialis Forearm: Skin (lateral side) – Nervus cutaneus antebrachii lateralis Nervus axillaris Posterior cord Penetrates foramen humerotricipitale Innervates teres minor and deltoideus Skin of deltoid region Nervus iliohypogastricus Nervus ilioinguinalis Nervus genitofemoralis Nervus obturatorius Nervus femoralis PLEXUS LUMBALIS rami ventrales nervorum spinalium L1 – L 4 innervation of abdominal wall, and partially lower extremity 5.12.2014 5 Nervus femoralis innervation of anterior group of thigh muscles Nervus saphenus Nervus obturatorius Canalis obturatorius Anterior and posterior branch Innervation of medial thigh muscles and skin PLEXUS SACRALIS Nervus glutaeus superior Nervus glutaeus inferior Nervus pudendus Nervus cutaneus femoris posterior Nervus ischiadicus rami ventrales nervorum spinalium L4 – S 5 Nervus glutaeus superior et inferior innervates gluteal muscles Nervus ischiadicus innervation of posterior group of thigh muslces innervation of posterior group of thigh muslces In distal third of thigh nervus ischiadicus is splitted and forms: Nervus fibularis communis Nervus tibialis 5.12.2014 6 Nervus fibularis superficialis Nervus fibularis profundus innervation of lateral group of crural muscles innervation of anterior group of crural muscles Nervus fibularis communis On the level of head of fibula is splitted Nervus fibularis superficialis Nervus cutaneus dorsalis medialis et intermedius Nervus fibularis profundus Innervation of muscles on the dorsum pedis Skin of adjacent sides of toe and second finger Nervus tibialis innervation of posterior group of crural muscles Nervus plantaris medialis et lateralis Innervation of foot muscles Skin - line through fourth finger Cranial nerves I – nervus olfactorius (smell) II – nervus opticus (eye) III – nervus oculomotorius IV – nervus trochlearis V – nervus trigeminus VI – nervus abducens VII – nervus facialis VIII – nervus vestibulocochlearis (ear) IX – nervus glossopharyngeus X – nervus vagus XI – nervus accesorius XII – nervus hypoglossus 5.12.2014 7 Nervus oculomotorius (N. III) From the midbrain – fossa interpeduncularis, sulcus nervi oculomotorii Nervus trochlearis (N. IV) From the dorsal side of midbrain Nervus abducens(N. VI) From the sulcus bulbopontinus Nervus trochlearis Musculus obliquus superior Nervus abducens Musculus rectus lateralis Nervus oculomotorius Remaining extraocular muscles Musculus ciliaris Musculus sphincter pupilae NERVUS OCULOMOTORIUS, TROCHLEARIS, ABDUCENS ganglion trigeminale NERVUS TRIGEMINUS (N. V) NERVUS OPHTHALMICUS (N. V1) ramus tentorii n. lacrimalis n. frontalis n. supratrochlearis n. supraorbitalis (r. med., r. later.) n. nasociliaris r. com. cum ggl. ciliari nn.ciliares longi n. ethmoidalis post. n. ethmoidalis ant. n. infratrochlearis NERVUS MAXILLARIS (N. V2) r. meningeus n. zygomaticus r.com.cum n. zygomatico n.zygomaticofacialis n.zygomaticotemporalis nn. pterygopalatini n. infraorbitalis nn. alveolares sup. rr. palpebrales inf. rr. nasales externi rr. labiales sup. 5.12.2014 8 NERVUS MANDIBULARIS (N. V3) r. meningeus Muscular branches: n. massetericus nn. temporales prof. nn. pterygoidei n. tensoris tympani n. tensoris veli palatini n. buccalis n. auriculotemporalis n. lingualis n. alveolaris inferior Takes chorda tympani (n. VII) NERVUS LINGUALIS NERVUS FACIALIS (N. VII) NERVUS FACIALIS in the canalis nervi facialis N. petrosus major (secretory innervation of small salivary glands and lacrimal glands) N. stapedius (m. stapedius) Chorda tympani (secretory innervation of submandibular and Sublingual glands, taste from anterior 2/3 of tongue!!!) 5.12.2014 9 NERVUS VII. - plexus parotideus Innervation of muscles of facial expression !!! Facial nerve paralysis Nervus glossopharyngeus (n. IX.) Sulcus lateralis posterior – medulla oblongata penetrates foramen jugulare ganglion superius et inferius n.tympanicus – secretory innervation of parotid gland r.sinus carotici - baroreflex rr. pharyngei – innervation of pharyngeal muscles and muscles of soft palate r.stylopharyngeus rr.tonsilares – sensoric innervation rr.linguales – taste from posterior 1/3 of tongue Nervus vagus (n. X) sulcus lateralis posterior penetrates foramen jugulare ganglion superius et inferius descens in caudal directioin and follows arteria carotis interna (then arteria carotis communis) and vena jugularis interna, attached to the esophagus and follow him to the thoric and abdominal cavity. Head: Pharynx Taste from the glottis Meninges Auricle Neck: Muscles and mucous membrane of larynx Trachea Esophagus Heart Thorax: Bronchioli Esophagus Abdominal cavity: Stomach Liver Kidney Intestins (left colic flecture) Genital glands 5.12.2014 10 Nervus accesorius (N. XI) sulcus lateralis posterior penetrates foramen jugulare Ramus internusAdded tto the n.X.- muscles of larynx Ramus externusm. trapezius + m. sternocleidomastoide us Nervus hypoglossus (n. XII.) sulcus lateralis anterior penetrates canalis nervi hypoglossi Motor nerve Innervation of intra- and extraglossal muscles Ansa cervicalis profunda AUTONOMIC NERVOUS SYSTEM FUNCTION: fylogenetically the oldest part of NS, control smooth muscles, glands, heart FUNCTIONAL DIVISIONS: Parasympaticus – anabolic reactions (store the energy) Sympaticus – catabolic function (release the energy) Enteric system MORPOLOGICAL DIVISIONS: Central Peripheral 5.12.2014 11 CENTRAL PART OF AUTONOMIC NERVOUS SYSTEM Hypothalamus (subsystem of limbic brain = visceral brain) HYPOTHALAMUS Ncll. hypothalamici ant. control parasympaticus Ncll. hypothalamici medii Control the sympaticus PARASYMPATICUS (cranio-sacral system) Ncl. parasympaticus n. III (ggl. ciliare) Ncl. parasympaticus n. VII (ggl. pterygopalatinum, ggl.submandibulare) Ncl. parasympaticus n. IX (ggl. oticum) Ncl. parasympaticus n. X (organs of neck, thorax, abdominal – until flexura coli sinistra!!!, genital glands) Sacral segments of spinal cord (S2-4), ncl. intermediolateralis (organs of pelvis except of genital glands) SYMPATICUS - system (cervico)-thoraco-lumbar Ncl. intermediolateralis (from C8 until L2) from C8 until L2 – radix ant. sp. nerve n. spinalis tr. sympaticus r.comm. albus TRUNCUS SYMPATICUS ganglia trunci sympatici (paravertebral) cervicalia 3 (sup., med., inf.) thoracica 10-11 lumbalia 4-5 sacralia 4-5 ganglion impar rami interganglionares GANGLION TRUNCI SYMPATICI – eferent fibres rr.comm. grisei (to the n. spinalis - skin) rr. vasculares (net around the arteries) To the organs: rr. viscerales (postganglionic fibres) nn. splanchnici (praeganglionic fibres, praevertebral and intramural plexus) Plexus cardiacus spf., prof. Plexus pulmonalis Plexus aorticus thoracicus Plexus oesophageus PRAEVERTEBRAL PLEXUSES – THORACIC CAVITY 5.12.2014 12 Plexus aorticus abdominalis Plexus coeliacus (ggl coeliacum dx. sin.) plexus gastrici plexus lienalis plexus hepaticus plexus duodenalis plexus pancreaticus Plexus mesentericus superior Plexus mesentericus inferior Plexus renalis et suprarenalis (plexus uretericus) Plexus testicularis (ovaricus) Plexus iliaci (plexus femoralis) PRAEVERTEBRAL PLEXUSES – ABDOMINAL CAVITY PRAEVERTEBRAL PLEXUSES – PELVIS Plexus hypogastricus superior (n. praesacralis) Plexus hypogastricus dx. a sin. Plexus hypogastricus inf.